Diabetes and Daily Aspirin

by Jessica Pyhtila, PharmD, BCPS, BCGP

Every year, it seems as if there is a new, conflicting expert recommendation about aspirin. In decades past, taking a daily aspirin was a routine part of heart health as we aged. However, over the past decade, new studies have shown that taking a daily baby aspirin might not be as helpful as we used to think.

That said, having diabetes can complicate expert recommendations on whether to take aspirin. Diabetes is a major risk factor for cardiovascular disease. In fact, cardiovascular disease is the leading cause of death for people with diabetes. For this reason, in some cases, aspirin remains a helpful option for preventing and treating cardiovascular disease in those who are at high risk.

But how do you know whether you are likely to benefit from aspirin? This article will explore some of the most recent recommendations from the U.S. Preventative Services Task Force, the American Diabetes Association, and the American Heart Association to help you and your doctor answer that question.

How Does Aspirin Work?

Aspirin works in a few different ways to help prevent and treat cardiovascular disease. First, aspirin is an antiplatelet drug. Small blood cell fragments called platelets help your body form clots. At times – like when you have a cut – this can be useful and help you stop bleeding. However, in other cases, platelets can aggregate inside your arteries and impede blood flow throughout the body, increasing your risk for a heart attack or stroke. Aspirin blocks platelets from aggregating, meaning they cannot form clots.

Aspirin also has anti-inflammatory effects. Because inflammation is involved in the development of cardiovascular disease and some cancers, aspirin is believed to help fight disease from this standpoint as well.

Aspirin Side Effects

Despite its benefits, aspirin has important side effects, which can be serious in some cases. These include:

  • Bleeding, including bleeding gums when you brush your teeth
  • Bruising
  • Nausea and vomiting
  • Stomach discomfort

Although some bleeding can be minor, other bleeding can be more serious. This includes stomach and intestinal bleeding as well as bleeding in the brain. Symptoms of serious bleeding can include but are not limited to:

  • Black, tarry stools
  • Bright red blood in your stool
  • Nosebleeds that do not stop within 15 minutes
  • Coughing up blood
  • Vomiting up bright red blood or a substance that looks like coffee grounds
  • Blood in your urine
  • Confusion
  • Passing out

In rare cases, a person may develop an aspirin allergy, which can lead to symptoms like rash, hives, and trouble breathing. Both serious bleeding and an allergic reaction are medical emergencies, and you should seek emergency care as soon as possible.

Talking To Your Doctor About Whether Aspirin is A Good Idea For You

Before starting or stopping aspirin, it is important to talk to your doctor. Based on your medical history and other medications, your doctor will be able to help you decide whether aspirin is a good idea. Factors to consider include:

  • Your medical history: If you are primary prevention, you may not benefit from aspirin as much as if you are secondary prevention for cardiovascular disease
  • Your bleeding risk: Some medical conditions, like a history of stomach ulcers, can increase your bleeding risk while on aspirin. In some cases, the risks of aspirin may exceed the benefits. Your doctor can let you know if taking aspirin is too risky or not.
  • Other medications you take: Aspirin is not the only blood thinner available. For example, more than 4 million Americans take the antiplatelet medication clopidogrel (Plavix), an aspirin alternative. It is possible that you are taking a medication that works similarly to aspirin. In some cases, this can make it more dangerous to take aspirin. Further, some medications can have drug interactions with aspirin, which may increase bleeding risk. This includes over-the-counter anti-inflammatory drugs like ibuprofen (Motrin) and naproxen (Aleve).
  • Your cardiovascular disease risk: If you do not currently have cardiovascular disease, the American College of Cardiology has developed an online tool to determine your risk of developing it within the next 10 years. This risk calculator can help your doctor determine whether you can benefit from additional medications like aspirin or a cholesterol-lowering drug like a statin.

Aspirin For Preventing Cardiovascular Disease in People With Diabetes

The U.S. Preventative Services Task Force has recently come out with a set of recommendations about whether or not a person should use aspirin to prevent cardiovascular disease. If you have not yet developed cardiovascular disease, including a heart attack or stroke, you fall into a category called primary prevention.

The task force states that in primary prevention, adults aged 40 to 59 years may have a small benefit from aspirin if they have a 10% or greater risk of developing cardiovascular disease. Since diabetes is such a strong risk factor for cardiovascular disease, many people with diabetes will fall into this category. However, the task force recommends against aspirin for adults aged 60 years or older. In general, the American Heart Association echoes the task force guidelines, although they more specifically recommend against aspirin for primary prevention in people with an increased bleeding risk.

That said, other organizations are sometimes more supportive of offering aspirin to people with diabetes who are primary prevention. For example, the American Diabetes Association supports offering aspirin at a dose of 75mg to 162mg daily to people with diabetes and cardiovascular risk factors. An aspirin dose of 162mg is approximately one or two 81mg “baby aspirin” that are widely used in the United States. The association recognizes that the benefit of aspirin may be small in preventing cardiovascular disease, but that it can make a difference especially when the person is high risk.

Aspirin For Treating Cardiovascular Disease in People With Diabetes

If you already have a cardiovascular disease diagnosis, you fall into a category called secondary prevention. It is so named because the goal at this point is to prevent additional cardiovascular events like recurrent heart attacks or strokes.

Aspirin is widely-considered a staple in secondary prevention for cardiovascular disease. For the most part, aspirin doses between 75mg and 162mg daily are recommended.

When a person is a good candidate for aspirin but cannot take it, due to an allergy for example, alternate agents like clopidogrel (Plavix) 75mg daily are recommended. Additionally, in certain cases, like after a surgical operation like a stent placement in a blood vessel, aspirin may be recommended alongside another blood thinner like clopidogrel on either a temporary or long-term basis.

Summing Up – If Aspirin Is Right For You

The decision of whether or not to use aspirin can be controversial – especially if you do not currently have cardiovascular disease. For this reason, it is best to first talk with your doctor before starting aspirin or stopping it if you currently take it. Your doctor will be able to advise you on the best course of action depending on your medical history and risk factors.

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